What is Quviviq?

Quviviq is a new drug that treats insomnia, a common problem that affects sleep quality and overall well-being. What is Quviviq? This article will attempt to address what Quviviq is and how it works.

Many people have difficulty falling, staying, or getting back to sleep after waking up too early. These issues can lead to tiredness, sleeping too much during the day, mood changes, memory problems, and trouble focusing, making daily life and activities harder [1].

How Quviviq works in under a minute

Don’t want to read the whole blog but still want to know how Quviviq works? Read this short summary to find out.

Quviviq or daridorexant uses a different way to help people sleep. Instead of just turning down overall brain activity, which is like using a sledgehammer to crack a nut, researchers looked for a more subtle approach. They thought, “Why not just switch off the part of the brain that keeps us awake?”

By doing this, Quviviq or daridorexant reduces wakefulness and helps you fall asleep without messing up your body’s natural sleep cycle.

Insomnia

The way insomnia is diagnosed has changed a lot, which has made treatment methods inconsistent, and sometimes, they can even make the problem worse. To simplify diagnosis, experts now classify insomnia into three types:

• short-term,
• chronic, and
• other.

Both the International Classification of Sleep Disorders (ICSD-3) and the Diagnostic and Statistical Manual of Mental Disorders (DSM-V) require symptoms to occur at least three times a week and to last for at least three months to diagnose chronic insomnia [2].

How is insomnia treated?

The most common treatment is cognitive-behavioural therapy for insomnia (CBT-I). Although it works well on its own, some doctors also recommend using short-term medication together with CBT-I [3].

Insomnia is usually diagnosed based on what a person reports about their sleep instead of using detailed sleep studies (polysomnography) in a lab. Research shows that people with insomnia often report their sleep differently in diaries compared to what sleep studies record [4].

Common medications for insomnia include benzodiazepines, Z-drugs, drugs that act like melatonin, and antidepressants that help you sleep [5].

How many people have insomnia?

Insomnia is a common problem. About 30% of people say their sleep is disrupted, and 10% to 15% have insomnia that meets clinical criteria because of ongoing sleep issues and related problems [7].

The cost of insomnia

This condition costs the US around $100 billion annually due to reduced work performance, increased healthcare use, and accidents [8].

Insomnia and ageing

Insomnia tends to increase with age, possibly because sleep changes naturally as we age, and older adults often have more health issues [9]. Women in every age group report more sleep problems than men [10].

What is Quviviq?

Idorsia Pharmaceuticals Ltd developed Quviviq or daridorexant to treat insomnia.

This medication works by blocking two types of receptors in the brain, called orexin, Type 1 and Type 2.

These receptors normally help keep you awake when they interact with natural chemicals called orexin A and orexin B (also known as hypocretin-1 and -2) [6].

How to take Quviviq?

The recommended dose of daridorexant is 25–50 mg once a night. It should be taken within 30 minutes before bedtime, and you should have at least 7 hours available to sleep.

How Quviviq works

Quviviq, or daridorexant, is a new, powerful sleep drug approved for people over 18 with insomnia [11]. It works by blocking orexin receptors (OX1R and OX2R), which normally help keep you awake.

To help explain how this works, it’s best to imagine receptors as locks and the molecules that interact with them as keys.

Usually, the natural chemical, orexin, is the key that fits into the lock, or the orexin receptor. When orexin binds to the orexin receptor, the key is in the lock, and the door to wakefulness is thrown open.

However, when we stop orexin from opening the lock, that is, when we stop it binding to the orexin receptor, the door to wakefulness is not open. If the door to staying awake is closed, it becomes easier to fall asleep because the brain is no longer receiving the signals to stay awake. By stopping orexin from binding to these receptors, daridorexant reduces excessive wakefulness. In studies, it helped patients sleep better at night and improved their performance during the day [12]

The history of Quviviq

Actelion Pharmaceuticals developed daridorexant. Later, when Johnson and Johnson bought Actelion in June 2017, it split off its drug research into a new Swiss company called Idorsia Pharmaceuticals [2].

Daridorexant was first approved in the United States on January 7, 2022, to help adults with insomnia who have trouble falling or staying asleep [11]. It was chosen from many options because a 25 mg dose works for about 8 hours, and its half-life is designed to avoid lingering effects that could affect daytime activities.

The drug was approved by the U.S. government in January 2022, then by the European Medicines Agency (EMA) in April 2022, and finally by the MHRA in the UK in September 2022[13].

Multiple clinical trials (Phase I, II, and III) have shown that daridorexant is well tolerated, improves sleep, and does not leave you feeling drowsy the next day [14].

What is orexin?

Orexin, a natural substance in the brain, plays a key role in controlling when we wake up, stay awake, and feel hungry [15].

There are two known orexin types (OXA and OXB) that bind to orexin Type 1 and 2 receptors (OX1R and OX2R). OXA primarily binds to OX1R, whereas OX2R has a dual affinity for OXA and OXB [19].

Since 1998, scientists have known about orexins (also called hypocretins), chemicals made by a group of neurons in an area of the brain called the posterolateral hypothalamus.

These orexins help activate many brain areas, including those that control sleep and wakefulness. Animal studies show that orexins keep you alert, control muscle tone and movement, manage hunger, and regulate other body functions.

Narcolepsy and lack of orexin

Early studies in animals, like dogs and rodents, showed that a lack of orexins can lead to narcolepsy—a disorder that makes people very sleepy during the day. Later, researchers found that 90% of people with a particular type of narcolepsy (narcolepsy with cataplexy) have very low or no orexin in their spinal fluid. At the same time, most other sleep or brain disorders show normal orexin levels.

Low orexin levels have also been found in cases of hypothalamic disorders, acute brain injuries, and a few other conditions  [19].

Daridorexant prevents the wake-promoting neuropeptide OXA and OXB from binding to OX1R and OX2R, inhibiting the wake urge.

Medications that block orexin receptors can make you feel sleepy and allow for longer sleep, which can be helpful for people with insomnia [16].

DORAs

Quviviq belongs to a new group of drugs called DORAs, which stands for Dual Orexin Receptor Antagonist. They work on different brain pathways than current sleep medications, which tend to increase the effects of the inhibitory neurotransmitter GABA.

The problems with zopiclone and zolpidem

Previously, the main treatments for insomnia focused on increasing the GABA activity in the brain. Insomnia medications, such as zopiclone, target the gamma-aminobutyric acid Type-A (GABA-A). It induces sleep by increasing the effects of GABA, but the problem is that it depresses the central nervous system (CNS) activity broadly [2]

The problem is that increasing the effects of GABA in the brain tends to leave you groggy the following day. A good analogy is to think of a city at night. One way to bring about a blackout is to cover the city with a thick GABA-induced blanket of fog. This is effectively what the Z drugs, such as zopiclone and zolpidem do.

Quviviq’s precise targeting

DORAs were developed to treat insomnia in a way that doesn’t leave you feeling like you have a hangover the next day.

The sleep-wake cycle is controlled by a balance between systems that promote sleep (like those using GABA) and systems that promote wakefulness (like those using orexin, acetylcholine, and other chemicals).

Quviviq works by blocking orexin, a natural brain chemical that promotes wakefulness. Orexin is mainly produced in the lateral hypothalamus, and it activates two types of receptors (Type 1 and Type 2) that keep you alert during the day and less active at night.

Quviviq targets this particular area of the brain, the lateral hypothalamus. It’s a more precise and elegant solution to promoting sleep. It simply targets the brain’s ‘ON’ switch.

Let’s go back to our city analogy. Rather than causing a blackout by causing a thick layer of fog to descend over the city, Quviviq will simply switch off the city’s power station, plunging the city into darkness.

To bring this analogy to life, have a watch of the video.

Quviviq is designed to optimise sleep and reduce side effects

Daridorexant was specifically designed to improve sleep without affecting one’s ability to think or stay awake the next day. It has also been shown to improve daytime function, helping one feel better throughout the day.

According to studies, daridorexant not only improves sleep but also helps you function better during the day [17]. It is generally safe and well-tolerated, with minor possible side effects such as headache, balance problems, tiredness, and mild cold-like symptoms [18].

Unlike older sleep medications that affect a wide range of brain areas, daridorexant specifically targets orexin neurons. This means it helps you sleep without causing unwanted side effects like next-morning grogginess or memory problems. Studies show that although daridorexant remains in your blood after waking up, it doesn’t impair your thinking or alertness.

In short, daridorexant helps you stay asleep for about 8 hours by blocking the signals that make you feel awake. This leads to better sleep at night and improved performance during the day.

Can you buy Quviviq online in the UK?

After completing the health questionnaire at medicalmojo.co.uk, you can buy Quviviq 50mg and Quviviq 25mg online in the UK. This short online consultation will help determine if Quviviq is safe for you.

If you want to learn more about Quviviq or other insomnia treatments, please email us at info@medicalmojo.co.uk or call us at 02381 575 111.

Need more help with sleeping issues?

Having trouble catching those Zzzs? Unsure about the right solution? Medical Mojo is here to support you with a FREE sleep consultation. We’ll guide you on the best methods to improve your sleep, whether it’s with melatonin, Quviviq, or personalised sleep coaching. Let us help you find the perfect sleep solution.

Disclaimer: This information is for educational purposes only and is not a replacement for professional medical advice.

References

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2. Tyagi, H., Sharma, A., Khera, N., Sharma, B., Bajaj, M. and Kaur, M., 2023. Daridorexant: A drug to treat insomnia.
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7. American Academy of Sleep Medicine. The AASM international classification of sleep disorders – third edition, text revision (ICSD-3-TR). Jun 2023
8. Wickwire EM, Shaya FT, Scharf SM. Health economics of insomnia treatments: the return on investment for a good night’s sleep. Sleep Med Rev. 2016 Dec;30:72-82.
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14. Muehlan C, Boehler M, Brooks S, Zuiker R, van Gerven J, Dingemanse J. Clinical pharmacology of the dual orexin receptor antagonist ACT-541468 in elderly subjects: An exploration of pharmacokinetics, pharmacodynamics, and tolerability following singledose morning and repeated-dose evening administration. J Psychopharmacol 2020;34:326-35.
15. Kukkonen JP, Leonard C. Orexin/hypocretin receptor signaling cascades. Br J Pharmacol 2014;171:314-31.
16. Janto K, Prichard JR, Pusalavidyasagar S. An update on dual orexin receptor antagonists and their potential role in insomnia therapeutics. J Clin Sleep Med 2018;14:1399-408
17. Hudgens S, Phillips-Beyer A, Newton L, Kinter DS, Benes H. Development and validation of the insomnia daytime symptoms and impacts questionnaire (IDSIQ). Patient 2021;14:249-68.
18. Zammit G, Dauvilliers Y, Pain S, Kinter DS, Mansour Y, Kunz D. Daridorexant, a new dual orexin receptor antagonist, in elderly subjects with insomnia disorder. Neurology 2020;94:e2222-32.
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